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Sir Richard Doll (1912-2005), Physician, Epidemiologist, Teacher, Humanitarian, Legend, A ctivist, Researcher, Public H PowerPoint Presentation
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Sir Richard Doll (1912-2005), Physician, Epidemiologist, Teacher, Humanitarian, Legend, A ctivist, Researcher, Public Health lobbyist . Smoking and Health. Cough. Gout. Asthma. Diseases of women. Headaches. Intestinal worms. Stomach cramps. Open wounds. Malignant tumours.

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slide1

Sir Richard Doll (1912-2005), Physician, Epidemiologist, Teacher, Humanitarian, Legend, Activist, Researcher, Public Health lobbyist

Smoking and Health

conditions treated with tobacco 16 th century

Cough

Gout

Asthma

Diseases of women

Headaches

Intestinal worms

Stomach cramps

Open wounds

Malignant tumours

CONDITIONSTREATED WITH TOBACCO16th Century
s mmering 1795 doctoral thesis
SÖMMERING 1795DOCTORAL THESIS

“Carcinoma of the lip is most frequent when people indulge in tobacco pipes. For the lower lip is particularly attacked by carcinoma because it is compressed between the pipe and the teeth”

slide5
PERCENTAGE OF MEN ATTENDINGMASSACHUSETTS CANCER CLINICSWITH DIFFERENT CANCERS: BY SMOKING HABIT(Potter & Tulley, 1945)
use of tobacco by disease category 86 men with and 86 men without lung cancer after m ller 1939
USE OF TOBACCO BY DISEASE CATEGORY:86 MEN WITH AND 86 MEN WITHOUT LUNG CANCER(after Müller, 1939)
smoking and lung cancer case control studies before 1950

Author

No. of men

Percent of:

Lung

cancer

Controls

Non-smokers

Heavy smokers

Lungcancer

Controls

Lungcancer

Controls

Müller, 1939Germany

36

86

3.5

16.3

65

36

Schairer &Schöniger, 1943Germany

93

270

3.2

15.9

52

27

Wassink, 1948Holland

134

100

4.5

19.0

55

19

SMOKING AND LUNG CANCERCASE-CONTROL STUDIES BEFORE 1950
tobacco and coronary disease english willius berkson 1940

Men aged(yrs)

Percent smokers

P*

Coronary disease

Others

40-9

79.7 (149/187)†

61.9 (187/302)

<0.001

50-9

71.7 (274/382)

73.9 (274/371)

60+

63.8 (275/431)

61.8 (202/327)

0.28

40+

69.8 (698/1000)

66.3 (663/1000)

0.05

*P, one-sided

†Number of smokers and all men in age group in parentheses

TOBACCO AND CORONARY DISEASE(English, Willius & Berkson, 1940)
tobacco and coronary disease english willius berkson 19409

Men aged(yrs)

Percent coronary disease in:

P*

Smokers

Non-smokers

40-9

4.8 (10/208)†

1.0 (2/208)

0.01

50-9

6.2 (24/388)

2.6 (10/388)

0.01

60+

5.0 (20/404)

6.4 (26/404)

40+

5.4 (54/1000)

3.8 (38/1000)

0.04

*P, one-sided

†Number of men with coronary disease and all diseases

in age group in parentheses

TOBACCO AND CORONARY DISEASE(English, Willius & Berkson, 1940)
smoking and lung cancer case control studies published in 1950

Author

No. of men

Percent of:

Lung

cancer

Controls

Non-smokers

Heavy smokers

Lungcancer

Controls

Lungcancer

Controls

Schreck et al.USA

82

522

14.6

23.9

18

9

Levin et al.USA

236

481

15.3

21.7

Mills & PorterUSA

444

430

7

31

Wynder & GrahamUSA

605

780

1.3*

14.6*

51

19

Doll & HillUK

649

649

0.3*

4.2*

26

13

*Lifelong non-smokers, with ex-smokers carefully excluded

SMOKING AND LUNG CANCERCASE-CONTROL STUDIES PUBLISHED IN 1950
mortality by amount smoked relative to that in non smokers after hammond horn 1954

Age(yrs)

No. ofdeaths

Regular cigarette smokerssmoking (per day):

Cause ofdeath

Less than10

10-19

20or more

50-69

167

42

8.8

lung cancer

50-54

377

1.7

2.1

2.5

coronary heart disease

55-59

571

1.1

1.9

2.1

60-64

594

1.5

2.2

2.0

65-69

605

1.0

1.3

1.1

MORTALITY BY AMOUNT SMOKEDRELATIVE TO THAT IN NON-SMOKERS(after Hammond & Horn, 1954)
berkson s alternatives
BERKSON’S ALTERNATIVES

“The findings were the result of the interplay of various subtle and complicated biases

or

had a constitutional basis, involving people who were non-smokers or relatively light smokers, being the kind who were biologically self-protective and this “correlated with robustness in meeting mortal stress from disease generally”

fisher s objections
FISHER’S OBJECTIONS

(i) Smokers with lung cancer reported inhaling less than smokers without (Doll & Hill, 1950) against causation unless it was concluded that “Inhaling cigarette smoke was a practice of considerable prophylactic value in preventing the disease”

fisher s objections16
FISHER’S OBJECTIONS

(ii) Secular changes in smoking habits could not be related to the increase in lung cancer since “lung cancer has been increasing more rapidly in men relative to women” while “it is notorious, and conspicuous in the memory of most of us, that over the last 50 years the increase among women has been great, and that the increase among men (even if positive) certainly small”

cancers caused in part by smoking international agency for research on cancer 2004

Bladder

*Lung

Oral (incl. lip & tongue)

Cervix

Myeloid leukaemia

*Oro- & hypo- pharynx

Kidney

Nasopharynx

Pancreas

*Larynx

Nose & nasal sinuses

Stomach

Liver

*Oesophagus

Ureter

*Increased more than fivefold

CANCERS CAUSED IN PART BY SMOKING(International Agency for Research on Cancer, 2004)
vascular and respiratory disease caused in part by smoking

*Pulmonary heart disease

Subarachnoid haemorrhage

Ischaemic heart disease

Cerebral thrombosis

Myocardial degeneration

Cerebral haemorrhage

Hypertension (fatal)

*Chronic obstructive lung disease

Arteriosclerosis

Pneumonia

*Aortic aneurysm

Asthma

*Peripheral vascular disease

Pulmonary tuberculosis

*Buerger’s disease

*Increased more than five-fold

VASCULAR AND RESPIRATORY DISEASECAUSED IN PART BY SMOKING
other conditions caused in part by smoking

Gastric ulcer

Periodontitis

Duodenal ulcer

*Tobacco amblyopia

Crohn’s disease

Age-related macular degeneration

Osteoporosis

Cataract

Reduced fecundity

Facial skin wrinkling

Reduced growth of fetus

*Palmoplantar pustulosis

*Increased more than five-fold

OTHER CONDITIONSCAUSED IN PART BY SMOKING
slide20
UK male doctors born 1900-1930: continuing cigarette vsnever smokers. 50-year follow-up of mortality, 1951-2001